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What to Consider Before Returning to Run After Childbirth
Posted June 06, 2023 by Amina Phelps, PT, DPT, Pelvic Floor Therapist
Some women feel ready and want to get back to running and exercise soon after childbirth. This is often encouraged as exercise has many physical and mental health benefits; however, keep in mind that pregnancy and childbirth produce unique changes in the muscles and ligaments of your pelvic floor, trunk, hips and feet. These changes can create an increased likelihood of:
- Urinary or bowel incontinence
- Pelvic organ prolapse
- Hip injury or pain
- Foot/ankle injury or pain
- Low back, tailbone, and buttocks injury or pain
- Changes to running gait1
Jumping back into more intense exercising too soon can sometimes exacerbate these symptoms. In fact, high-impact exercise, such as running, has been found to increase risk of pelvic floor dysfunction – urinary stress incontinence, urinary urge incontinence, overactive bladder, pelvic organ prolapse, pelvic pain, and fecal or anal incontinence – nearly five-fold compared to lower impact exercise, like walking and swimming, if proper, progressive steps aren’t taken. While one in four women in general experience at least one of these conditions, studies have found around a 30% prevalence of urinary incontinence in post-partum runners.2 Those with persistent incontinence at three months post-partum have a significantly greater likelihood of continued incontinence at five years post-partum.3
What’s more, postpartum runners have been found to land with more force as a result of weakness in their hips and decreased hamstring flexibility, compared to those runners who have not given birth. Changes in hormones during pregnancy and if you are breastfeeding can cause your ligaments to become more lax leading to reduced stability of the joints. Some find that their shoe size changes due to these ligamentous changes, for example. Therefore proper strength training is essential, including strengthening the small muscles of your feet and ankles.
Some post-partum circumstances may further warrant additional healing time prior to resuming high-impact tasks.4 Your level of energy, nutrition, lactation, quality and quantity of sleep, pain and fatigue should all be considered by you and your provider when deciding how and when to return to running. Typically, it is recommended that you refrain from running if you currently have:
- Grade 2, 3 or 4 pelvic organ prolapse
- Any type of incontinence when running
- Diastasis recti (greater than two finger-widths)
- Sacroiliac pain, pubic symphysis pain or sciatica
It’s never too late to address these issues, as symptoms can arise months to years after you delivered your baby. Many of these symptoms are very common, however they should not be considered “normal.” Consider mentioning any symptoms to your medical provider and pelvic health physical therapy may be warranted. The Summa Health Pelvic Health Physical Therapy team – currently located at five outpatient sites – would be happy to help you get back to your running and exercise goals. To learn more, visit summahealth.org/pelvic-health.
Amina Phelps, PT, DPT
2. Lourenco T, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal (2018) 29:1757-1763. And Moore IS, James ML, et.al. Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum females.
3. Viktrup L, Lose G. The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol. 2001;185(1):82-87.
4. Selman R, et. al. Maximizing recovery in the postpartum period: a timeline for rehabilitation from pregnancy through return to sport. International Journal of Sports Physical Therapy. Vol 17, Issue 6, 2022.